scott@vtx-cpd.com
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Hello Amanda.
Hope you are well. Campylobacter can indeed be tricky. I would often not treat.
The majority of cases are uncomplicated, self-limiting and resolve with supportive therapy. Because isolation of Campylobacter does not confirm causation, treatment may not be warranted. Antibiotics may further disrupt intestinal microflora. However, in animals that are immunocompromised, febrile, or with evidence of hemorrhagic diarrhoea, antimicrobial treatment may be indicated. The drugs of choice are the macrolides (erythromycin at 10 to 15 mg/kg q 8 h) or fluoroquinolones (enrofloxacin at 10 mg/kg q 24 h). Fluoroquinolones are not used initially due to their high rate of mutational resistance and obviously I would avoid enrofloxacin in cats completely. You could consider marbofloxacin. The macrolides such as erythromycin (10-20 mg/kg q 8 h for 7 days, despite possible gastrointestinal side-effects) or azithromycin (5-10 mg/kg q 24 h for 7 days) are the drugs of choice.
I would only treat if all else fails!
Scott 🙂
Replying to Raquel M. 25/04/2022 - 03:49
Hello Raquel.
Thank you so much again for your questions. I have heard of this higher dose, but I must admit I don’t use it routinely. I will ask some anaesthesia pals too and see what their thoughts are.
I would agree about not using buprenorphine longer term. I would normally use for not more than 7 days at a time.
Hope that helps.
Scott 🙂
Hello.
Thank you so much for your question.
Oral transmucosal buprenorphine is used off-licence for postoperative pain and “flare ups” of pain in patients with chronically painful conditions. It appears to be efficacious in cats, with varying reports of effectiveness (Robertson et al, 2005; Giordano et al, 2010). The original pharmacokinetic paper indicated 0.02mg/kg buprenorphine administered oral transmucosally produced similar, if not better, analgesia than when administered IV or SC, but a later paper suggested IV produced more profound analgesia. The difference may be due to the type of stimulus and the dose of the drug used. The formulation of the buprenorphine appears to affect how well the patient tolerates medication, with single use vials being tolerated well compared to buprenorphine from multi-use vials (Bortolami et al, 2012).
The IV formulation can be used orally. The vials tend to be better tolerated orally compared to the multi dose bottles as there is not the same preservative.
I tend to use it at the 0.02-0.03mg/kg TID when using orally. I have indeed heard of people using at higher doses. This is not something I would normally use long term, but it could be considered in some patients. As I said, this would be a drug I would use for flare ups or in the more acute phases of disease. I would normally use for no longer than a week at a time.
Hope that helps.
Scott 🙂
This is a brilliant question.
I did not mention these products during the pancreatitis webinars as it is not something I use routinely… however, I am wondering if I should. There is basically very little evidence, but it makes perfect sense.
There is some rationale to consider antioxidant therapy in patients with pancreatitis. Vitamins C and E, silybin, S-Adenosylmethionine (SAMe), and omega-3 fatty acids could be prescribed. Veterinary products, Marin™ (vitamin E and silybin), Denosyl® (SAMe), and Denamarin® (SAMe and silybin), manufactured by Nutramax Laboratories, Inc., are available.
Would be interested to see if others use these sorts of products in these cases.
Scott 🙂
Hello.
It really depends. Coccidia generally are considered to be minor pathogens in dogs and cats, causing disease in young or immunosuppressed patients, but Giardia infection can be clinically significant. The trichomonads (Tritrichomonas foetus, Pentatrichomonas hominis, Balantidium coli and Entamoeba histolytica) are colonic inhabitants.
Did they give any more information on what they could be? Can you share the report?
Scott 🙂
Replying to Emma Holt 08/04/2022 - 17:24
Hey.
Prednisolone seems to to be the main part of treatment in these cases. This case was treated with 2mg/kg/day of prednisolone.
There is an uncertain role of bacteria in these cases and many are also treated with antibiotics. The biggest case series in these cases is here:
https://pubmed.ncbi.nlm.nih.gov/25896239/
I think FISH staining is a useful addition in these cases if possible.
Some cases also undergo some sort of debulking surgery.
This cat did very well with steroids alone!
Scott 🙂
Replying to Nathalie Cunha 08/04/2022 - 16:55
Hello again!
We chatted a bit about this at the live Q&A too… I hope that helped!
Scott 🙂
Hey Emma.
I hope you are having a wonderful time away in Scotland!
This is a nice review and raises some good points:
1. I would still use endoscopy in cats with diffuse disease. I have experienced ‘missing’ a diagnosis of lymphoma in both dogs and cats with endoscopy, so this can definitely still happen. I always warn owners of this possibility. I think the key think with feline endoscopy particularly is aiming to get to all areas. I would always biopsy from ilium and duodenum. If there was any concern about not achieving this, I would consider surgical biopsies.
2. I would actively avoid endoscopy if US demonstrated lesions beyond my reach… mid jejunum!
3. I would always consider surgical biopsies if there was questions regarding disease in other organs (liver and pancreas).
There are pros and cons to both endoscopy and surgery, but I will still consider endoscopy due to the less invasive nature.
Hope that helps.
Scott 🙂
Replying to Ellen Marie Andersen 18/04/2022 - 21:58
Hello Ellen.
This is a really interesting point and really interesting paper. It is certainly well recognised that reflux oesophagitis is a common reason for human patients to present with coughing.
When there is very severe reflux, there is all a well established link with the development of nasopharyngeal stenosis.
The other main link with respiratory and gastrointestinal disease would be the brachycephalic dogs:
https://pubmed.ncbi.nlm.nih.gov/33187623/
https://pubmed.ncbi.nlm.nih.gov/30094894/
https://pubmed.ncbi.nlm.nih.gov/16512845/
https://pubmed.ncbi.nlm.nih.gov/15971897/I think there may be an indication for PPI’s in some respiratory cases, but I would be keen to get to the bottom on the underlying disease.
Thanks again for sharing!
Scott 🙂
Replying to Raquel M. 14/04/2022 - 14:09
Hello again.
The chemotherapy induced diarrhoea is a great question. Generally I would indeed treat as uncomplicated diarrhoea. There is not a uniform consensus on exactly how to deal with these cases. Generally, I would not be reaching for metronidazole, but I know some will in these cases. There is not not evidence to support the use of metronidazole in acute cases of diarrhoea. The following study actually demonstrated good results when treating these cases with medical clay:
Chemotherapy-induced diarrhoea in dogs and its management with smectite: Results of a monocentric open-label randomized clinical trial
Abstract
Chemotherapy-induced diarrhoea (CID) is a frequent chemotherapy adverse event in dogs. Yet, there is currently no consensus regarding its management. Smectite is a natural medical clay, widely used in the treatment of acute diarrhoea in humans. The objectives of this study were to assess the efficacy of smectite in the management of CID in dogs, and to collect epidemiological data on CID. For each episode of diarrhoea, dogs were randomized into two management groups: Smectite group, receiving smectite at 0.5 g/kg PO per day divided in two to three doses initiated at the start of CID; control group, without initial medication. In both groups, rescue metronidazole was prescribed if CID progressed or was not improved within 48 hours. Sixty dogs were recruited and received 426 chemotherapy administrations between June 2017 and March 2019. The incidence rate of CID was 110/426 (25.8%, 95% CI: 21.7%-30.2%), and significantly differed between the chemotherapeutic drugs administered (P < .001). Metronidazole was administered in 5/54 events (9.3%, 95% CI: 3.1%-20.3%) in the smectite group and in 40/56 events (71.4%, 95% CI: 57.5%-82.3%) in the control group (P < .001). The time to resolution of diarrhoea was shorter (P < .001) in the smectite group (median: 19.5 hours, interquartile range [IQR]: 13.5-32 hours) compared with the control group (median: 53 hours, IQR: 31.5-113.5 hours). The results of this study support the administration of smectite in the first-line management of CID in dogs. Often, the cases that do require antibiotics would be those that become significantly neutropenic. We have Katie (oncology specialist) joining us for later session and I will make sure to ask this question to her during the second live Q&A. Hope that helps. Scott 🙂Replying to Raquel M. 14/04/2022 - 14:09
Hello.
I hope you are well. Regarding sucralfate, I would not use it in this way. Constipation is indeed a side effect, but actually not that common. As you also mention, the tablet form is really very ineffective and if I was using sucralfate, I would always use a slurry.
I have had a look through the literature and can find no data regarding the use of sucralfate for diarrhoea.
Hope that helps.
Scott 🙂
Replying to konstantinos C. 15/04/2022 - 17:06
Hey.
Great question. I would definitely use maropitant in these cases to deal with any nausea at play. The maropitant is unlikely to have a significant impact on the actual reflux events. It will help with nausea, but not prevent reflux.
In certain cases omeprazole could be used to help increase the pH of what is refluxed and cisapride may help prevent reflux:
https://pubmed.ncbi.nlm.nih.gov/22489656/
I hope that helps.
Scott 🙂
Hey.
The links did not seem to work for the papers… here they are:
https://onlinelibrary.wiley.com/doi/full/10.1111/jvim.16379
https://onlinelibrary.wiley.com/doi/full/10.1111/jvim.16405
https://drive.google.com/file/d/1kEqLRWf1Oujp7_Kw2m2QsjS_G5vK_N1x/view?usp=sharingThanks.
Scott 🙂
Replying to Rachel O. 09/04/2022 - 07:05
Hello.
Lovely to hear from you. Things have been so crazy in the veterinary world, we totally understand.
You should have access to the material for one year from the start date of the course.
If you have any problems accessing the material let me know.
I hope you are enjoying the course so far.
Scott 🙂
Replying to Raquel M. 12/04/2022 - 13:02
Brilliant!
I have to be very honest and say that I had to Google where exactly the Cayman Islands were!
Looks amazing!
Scott 🙂
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